Speciation and antifungal susceptibility profiles of candida species in Lebanon : a nation-wide study

Abstract

Invasive fungal infections have presented a challenge in treatment when it comes tohospitalized patients. In the past, it has been known that the frontrunner in such infections isCandida albicans with little emphasis placed on non-albicans Candida (NAC) species aspossible culprits. This has changed drastically over the last decade where studies worldwidehave shown a rise in fungal infections attributed to NAC spp. that include Candida glabrata,Candida tropicalis, Candida parapsilosis, and many other species. The aim of this study is toincrease the knowledge of NAC infections in Lebanon along with an epidemiologicaloverview of resistance in Lebanese hospitals.This two year study is an observational multi-central epidemiological study thatfocuses on collecting samples of NAC spp. from 14 hospitals across Lebanon between theperiod of September 2016 and May of 2018. The focus was on the distribution of NAC spp.in Lebanon and their profiles of resistance to common antifungals. A total of 616 isolateswere collected from 14 different hospitals distributed all over the country and cultured onSabouraud dextrose agar (SDA). Growth of Candida spp. was performed on SabouraudDextrose Agar and the phenotypic identification was done using the Germ Tube Test (GTT)the API 20C AUX-system. Susceptibility testing was evaluated by determining the MinimumInhibitory Concentration (MIC) in broth (microdilution) for 3 antifungals that are:posaconazole, micafungin and caspofungin.Out of the 616 collected isolates, 500 were identified and 106 underwentsusceptibility testing for the 3 antifungal agents. Out of the 500 identified isolates, 158Candida albicans were misidentified as NAC spp. by the aforementioned hospitals and weresent as part of my study. As for NAC spp., 342 isolates were positively identified withCandida glabrata being the most isolated species 128 (38%) followed by Candida tropicalis87 (26%), Candida parapsilosis 31 (9%), Candida famata 29 (8%), Candida kefyr 28 (8%),Candida krusei 15 (4%), and different NAC spp. 22 (7%). Susceptibility of these isolates toantifungals was 88.67% for posaconazole, 98.22% for micafungin and 10% for caspofungin.The shift in invasive fungal infections to NAC spp. is alarming on multiple levels dueto the different antifungal susceptibility patterns and the lack of local guidelines to guidetreatment. Proper identification of such organisms is of utmost importance in order todecrease morbidity and mortality